Following her article in The Link magazine, we were fortunate enough to catch up with Kathrin Buckeridge, renowned specialist SaLT, to delve more into her insight on ABI.

What collaborative strategies between the parents and the school would you recommend, or in your experience, have been particularly beneficial to the child?

The first few months following a child’s return to school following ABI can be particularly challenging. Teachers and peers expect them to behave as they did before and it is common for the children themselves to have poor insight into their difficulties. They will need support to cope with the school environment in addition to possible extra help in the classroom. Our team at Chailey Clinical Services invites representatives from a child’s school to a discharge planning meeting toward the end of their rehabilitation period with us. This provides a supportive forum for the parents, child, Head Teacher, SENCo, and community therapists to plan with us for the transition. After a few weeks, we organise a follow-up meeting at the school to review how the child and the school team are coping. Allocating a key person in the school who is responsible for implementing recommendations and meeting regularly with the parents and child is important to ensure a smooth return. It is important to recognise that parents have seen their children survive an incredibly traumatic event but are now faced with changes to their child’s cognitive and physical abilities. With the agreement of the parents, it can be helpful for children to maintain contact with their friends from school during the rehabilitation period. Sharing information with other children in the school, again with parents’ agreement can help them understand how the child might be different to the one they knew previously. One young girl helped me prepare a PowerPoint presentation, which we delivered to teaching staff to explain how her stroke had affected her skills and what she needed particular help with. This was a powerful way of exchanging information and an empowering process for her.

Commonly will the ‘fatigue’ that children experience following ABI lessen and processing time become less? How can the staff and other children support this during the school day, especially during busy periods; break, the lunch hall, PE, etc?

The fatigue that children experience following ABI can stay with them for many years but as suggested may decrease over time as the child’s brain learns to adapt. It is important to ensure that information about a child’s ABI is passed on from one teacher to the next so that the potential impact of this remains highlighted. A child with ABI is usually having to work much harder than a typically developing child on the same task and this can be exhausting. Initially, we recommend that a child returns to school part-time, this might be for a certain number of days per week or mornings only and build up gradually to full-time attendance. We suggest that children who struggle with fatigue during the day have scheduled rest breaks or a way of letting their teacher know that they need a time-out. Schools have usually been able to provide a quiet place where a child can rest or have lunch with a friend. If a school is particularly large and busy then a child could be allowed to leave the lesson five minutes early to avoid the rush in the corridor. For some children contact sports are not recommended for a year after a brain injury but they may be able to take part in other activities. Check with a child’s consultant or physiotherapist and if necessary, make alternative arrangements for PE lessons.

In your opinion if a school could put in place just one strategy for a child with ABI what would it be?

Each child with ABI tends to have a unique set of strengths and weaknesses so we would tailor strategies to the individual child based on our assessments and what we have found works in therapy sessions during the rehabilitation process. From a Speech and Language Therapy point of view, the one area I find myself talking about most often is word-finding difficulties. A ‘word finding difficulty’ is when a child knows and understands a particular word but has difficulty retrieving it and using it in their speech or written work. Children I have worked with often use words that are similar to the ones they want but not the exact ones and this can be very frustrating for them. Often this difficulty can be very subtle to observers, but it can significantly affect how a child feels they are perceived by others and they describe their thoughts as being ‘locked inside their heads. One of the participants in my research study was worried that teachers didn’t think she was bright enough because she would stumble over saying words in the classroom. Meeting new people, stress (exams) and fatigue can make the word-finding problem worse and it can continue many years after the ABI. Make sure you give a child enough time to give their answer your question without putting them under pressure. They may also need extra time for written work, as word-finding difficulties affecting that can be overlooked. If you have any language groups at school, working on vocabulary skills then a child may benefit from taking part in these or specific work with a TA. Ideally, ask a speech and language therapist approach is recommended for a particular child with ABI.

Do you have any transition tips for schools to support children leaving primary school for secondary?

Ensure that the secondary school is armed with knowledge about a child’s ABI and any difficulties they continue to experience. If the ABI happened in early childhood then this information can become dissipated and teenagers are not keen to highlight why they are different from their peers. As well as the usual familiarisation days offered by secondary schools, it there are other professionals involved with a child, a meeting with the child’s form tutor, pastoral support team and SENCo will help to plan a smooth transition. Specific work with a child before they leave primary school to help them with more complex planning skills for example; organising homework tasks, reading a timetable or moving between lots of different classes would help prepare them. Children with ABI are often well supported in primary schools by teachers and assistants who know them really well but once they move to a larger secondary school their needs can go unmet. This is when they are in danger of problems with behaviour, as they fail to keep up with the pace of teaching and demands of the curriculum. It may not be until adolescence when more complex aspects of executive and language skills are developing that the full effects of ABI become apparent, so this needs highlighting for the secondary school. We often see children referred to our therapy-led ABI clinic at secondary school age because they are failing to cope with the increased challenges of the secondary school environment. Once funding has been agreed upon, we will then reassess a child and provide recommendations and support to the child, family and school.

What in particular prompted your interest in specialising in ABI in children?

My first post as a community Speech and Language Therapist involved working in a number of mainstream and special schools. I particularly enjoyed the opportunity to work regularly with a caseload of children with learning disabilities and wanted to specialise in complex neuro-disability, so applied for a post at Chailey Clinical Services (Sussex Community NHS Foundation Trust). When training to be a Speech and Language Therapist on placement, I worked with a teenager who had been knocked over by a car. His communication skills were quite unique, and we had to do some very lateral thinking. When the opportunity arose to work at our on-site Children’s Rehabilitation Service, I jumped at the chance. Working in the field of ABI is fascinating as each child is unique. Two children might have the same type of brain injury but present with a completely different set of impairments. Every day there is something new to learn in supporting a child and their family through rehabilitation. I love working as part of a multi-disciplinary team and having opportunities to problem-solve with therapists from other disciplines. Of course, it is rewarding to work directly with children who make significant improvements in their speech and language skills during the time they spend with us and make a successful transition back to school. For children with more severe brain injuries, the needs of the child and the family are very different but helping them through the initial period of recovery and adaption can be both fulfilling and humbling.

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